Outcomes of Tigecycline-based Versus Colistin-based Therapy in the Treatment of Multidrug-resistant Acinetobacter baumannii Pneumonia
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Abstract
Objectives: To compare outcomes of patients with multidrug-resistant Acinetobacter baumannii (MDRAB) pneumonia receiving tigecycline-based, colistin-based and tigecycline-colistin (TC) combination regimen in terms of 30-day mortality rate, clinical improvement, acute kidney injury and liver injury during the treatment. Predictors of 30-day mortality were also identified.
Methods: A retrospective study was conducted between January 2012 and December 2015 at Sawanpracharak Hospital, a tertiary care center in Thailand. Adult patients with MDRAB pneumonia treated with tigecycline and/or colistin for more than 3 consecutive days were included in the study.
Results: There were 264 patients (61% male) who met the inclusion criteria. The median age was 65 years. Patients were categorized into three groups: tigecycline-based (n=66), colistin-based (n=85) and TC-combination (n=113). The 30-day mortality rates were 62.1%, 45.9% and 58.4% (p>0.05), clinical improvement 34.8%, 49.4% and 39.8% (p>0.05), acute kidney injury 15.2%, 47.1% and 58.4% (p<0.05) and liver injury 16.7%, 5.9% and 7.1% (p<0.05), respectively. Comparison of the 30-day mortality rates of tigecycline-based versus colistin-based showed that the mortality rate of the tigecycline-based group was significantly higher (p<0.05). Logistic regression analysis identified septic shock (OR 3.11; 95% CI 1.81-5.34), tigecycline-based regimen (OR 2.83; 95% CI 1.33-6.01), acute kidney injury (OR 2.30; 95% CI 1.29-4.09), Charlson Comorbidity Index (CCI) more than or equal to 5 (OR 1.98; 95% CI 1.018-3.87) and age more than 60 years (OR 1.77; 95% CI 1.04-3.04) as predictors of 30-day mortality.
Conclusions: Patients with MDRAB pneumonia receiving tigecycline-based regimen had a significantly higher 30-day mortality rate than those receiving colistin-based regimen. Predictors of 30-day mortality included septic shock, tigecycline-based regimen, acute kidney injury, CCI more than 5 and age more than 60 years
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References
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